Risk Factors for Endothelial Cell Loss after Phacoemulsification: Comparison in Different Anterior Chamber Depth Groups

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Abstract

Purpose

To assess the risk factors for endothelial cell loss after phacoemulsification with implantation of intraocular lens according to anterior chamber depth (ACD).

Methods

This prospective study included 94 eyes of 94 patients undergoing phacoemulsification cataract surgery. To assess the risk factors for corneal endothelial cell loss, we examined seven variables at 1 day, 1 week, 6 weeks, and 12 weeks postoperatively in each ACD-stratified group.

Results

Multiple linear regression analysis showed that the only variable influencing the percentage decrease in corneal endothelial cell density throughout the postoperative follow-up period in the long ACD group (ACD III) was nucleosclerosis. The variables influencing the percentage decrease in corneal endothelial cell density in the short ACD group (ACD I) at one day and one week postoperatively were corneal incisional tunnel length and nucleosclerosis.

Conclusions

Risk factors for endothelial cell loss after phaoemulsification were different according to ACD. Long corneal tunnel length can be one of the risk factors for endothelial cell loss in short ACD eyes.

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Most cited references 16

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Risk factors for corneal endothelial injury during phacoemulsification.

Lilian Hayashi, F Nakao, H. Hayashi … (1996)

To determine the principal risk factors for corneal endothelial injury during phacoemulsification. Hayashi Eye Hospital, Fukuoka, Japan. We prospectively investigated 859 consecutive eyes of 800 patients who had had phacoemulsification surgery. The percentage of corneal endothelial cell loss at 3 months after surgery was quantitated using specular microscopy. The firmness of the nucleus was graded by Emery's classification prior to surgery. We selected nine variables that could be associated with endothelial injury. The univariate associations between the endothelial cell loss and these variables were evaluated using simple correlation coefficients. A multiple linear regression analysis was performed to identify independent predictors of endothelial cell loss. In the simple regression analysis, older age, small pupil diameter, high nucleus grade, large nucleus, greater infusion volume, type of IOL implanted, and a greater amount of total emitted ultrasound energy were univariately associated with endothelial cell loss. In the multiple linear regression analysis, the best final model (R2 = 0.42) identified high nucleus grade, greater infusion volume, type of IOL implanted, and large nucleus as independent predictors of endothelial cell loss. Both univariate and multivariate analyses identified the firmness of the nucleus as the most significant risk factor for endothelial cell loss. Therefore, mechanical contact with nuclear fragments is considered the principal cause of endothelial injury.

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Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters.

T Walkow, N Anders, S Klebe (2000)

To evaluate the effect of the location of the corneoscleral tunnel incision as well as preoperative and intraoperative parameters on total and localized endothelial cell loss. Department of Ophthalmology, Humboldt-University of Berlin, Berlin, Germany. Fifty consecutive patients scheduled for routine cataract surgery were selected prospectively for this clinical trial. Preoperatively, the axial length, anterior chamber depth, lens thickness, and astigmatism were measured. Phacoemulsification time and relative energy as well as total surgical time were recorded. With a specular microscope, endothelial cell counts were determined centrally, superiorly, and temporally preoperatively and 6 weeks and 6 and 12 months postoperatively. After 12 months, the mean overall central endothelial cell loss in all eyes was 8.5%. The mean endothelial cell loss was 11.9% in the lateral quadrant and 11.4% in the superior quadrant. There were no significant differences between superior and temporal surgical approaches in intraoperative parameters of phacoemulsification time, relative intensity of phacoemulsification, and surgical time. There were no significant differences in central endothelial cell loss or in the area localized in the quadrant of the positions of the corneal surgical site. The only risk factors found significant for higher endothelial cell loss were shorter axial length and longer phacoemulsification time. The location of corneoscleral incisions for phacoemulsification can be chosen according to the preoperative astigmatism without inducing additional adverse effects on the corneal endothelium. Shorter eyes have a significantly higher risk for greater endothelial cell loss.

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Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique.

J Nørregaard, Mogens Pedersen, Shakil Ahmed … (2008)

To compare endothelial cell damage during cataract surgery performed using the divide-and-conquer or phaco-chop nuclear fracturing technique. Department of Ophthalmology, Frederiksberg University Hospital, Frederiksberg, Denmark. In a prospective study, 60 eyes of 60 patients were randomly assigned to 1 of 2 groups (30 eyes each group) based on the phacoemulsification technique used: phaco chop or divide and conquer. During surgery, phaco time, phaco power, irrigation volume, and grade of nuclear firmness were recorded. The endothelial cell density, variation in endothelial cell size, percentage of hexagonal cells, and central corneal thickness (CCT) were recorded at baseline and 3 and 12 months postoperatively. Sample size was based on a power calculation (power 0.90, P = .05, clinically important difference = 300 cells/mm2). Significantly less phaco power was used during phaco-chop surgery than during divide-and-conquer surgery. Postoperatively, both groups had a significant but equal decrease in cell density. There were no statistically significant changes in variation in endothelial cell size, percentage of hexagonal cells, or CCT. Visual acuity increased significantly and equally in the 2 groups. Higher endothelial cell loss was significantly correlated with shorter axial length. It has been suggested that the phaco-chop technique is less harmful to the corneal endothelium than the divide-and-conquer technique because it uses less phaco power. The findings did not support this hypothesis as similar and low cell loss was observed in the 2 groups.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Ophthalmol

Journal ID (publisher-id): KJO

Title: Korean Journal of Ophthalmology : KJO

Publisher: The Korean Ophthalmological Society

ISSN (Print): 1011-8942

ISSN (Electronic): 2092-9382

Publication date (Print): February 2010

Publication date (Electronic): 05 February 2010

Volume: 24

Issue: 1

Pages: 10-15

Affiliations

[1 ]Department of Ophthalmology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

[2 ]Department of Veterinary Surgery, KonKuk University, Seoul, Korea.

[3 ]Department of Ophthalmology, Seoul St. Mary Hospital, The Catholic University of Korea, Seoul, Korea.

Author notes

Reprint requests to Man Soo Kim. Department of Ophthalmology, The Catholic University of Korea, Seoul St. Mary Hospital, #505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel: 82-2-2258-6197, Fax: 82-2-599-7405, mskim@ 123456catholic.ac.kr

Article

DOI: 10.3341/kjo.2010.24.1.10

PMC ID: 2817817

PubMed ID: 20157408

SO-VID: 615c0ee0-2fcc-4aeb-9517-3c2f87d06b29

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Risk Factors for Endothelial Cell Loss after Phacoemulsification: Comparison in Different Anterior Chamber Depth Groups

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Abstract

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Methods

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Karger: Ophthalmology

Most cited references 16

Risk factors for corneal endothelial injury during phacoemulsification.

Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters.

Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique.

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